Infecciones del tracto genital y urinario como factores de riesgo para parto pretérmino en adolescentes / Genitourinary infections as risk factors for preterm delivery in teenagers

Objetivo: Determinar las infecciones genitourinarias como factores de riesgo para parto pretérmino en adolescentes. Método: Estudio de casos y controles en las Unidades de Medicina Familiar del IMSS Querétaro, periodo octubre 2010 a octubre 2011. Se incluyeron 35 adolescentes con parto pretérmino y 148 con parto a término, mediante muestreo no aleatorio por cuota; se excluyeron aquellas con preeclampsia, eclampsia u otras enfermedades. Los datos se recolectaron del expediente clínico electrónico. Se estudiaron variables sociodemográficas; antecedentes gineco-obstétricos; tipo de parto (pretérmino y término); e infecciones urinarias y vaginales. La infección de vías urinarias fue diagnosticada mediante urocultivo y/o examen general de orina, con >105 UFC y >10 leucocitos por campo, respectivamente. La infección vaginal se diagnosticó por exudado vaginal con reporte de patógenos y/o por clínica. El análisis se realizó con porcentajes, promedios, chi2, razón de momios (Odds Ratio), prueba de t e intervalo de confianza. Resultados: De las adolescentes con parto pretérmino el 54,3 por ciento presentaron infección de vías urinarias, mientras que solo 33,8 por ciento de estas presentaron parto a término (p=0,02). El 57,1 por ciento de las adolescentes con parto pretérmino presentaron infección vaginal en comparación con 35,1 por ciento de las de parto a término (p=0,01). Conclusión: Las infecciones vaginales y urinarias incrementan dos veces el riesgo de presentar parto pretérmino en adolescentes.

Objective: To determine genitourinary infections as risk factors for preterm delivery in teenagers. Method: Case-control study in the Family Medicine Unit IMSS Querétaro, from October 2010 to October 2011. We included 35 teenagers with preterm delivery and 148 who delivered at term, using non-random sampling, we excluded those with preeclampsia, eclampsia or other diseases. Data were collected from electronic medical record. We studied socio-demographic variables, gyneco-obstetrics antecedents, mode of delivery (preterm and term), and genitourinary infections. Urinary tract infection was diagnosed by urine culture or urinalysis, with > 105 CFU and >10 leukocytes per field, respectively. Vaginal infection was diagnosed by vaginal culture with report of pathogens and / or by clinic. The analysis was performed using percentages, averages, chi-squared test, odds ratio, t-test and confidence intervals. Results: The 54.3 percentof the teenagers with preterm delivery had urinary tract infection, while only 33.8 percent of those with term delivery presented it (p = 0.02). Also 57.1 percent of adolescents with vaginal infection had preterm delivery compared with 35.1 percent of those giving birth at term (p=0.01). Conclusion: Vaginal and urinary infections increase twice the risk of preterm delivery in teenagers.

Factores influyentes en el bajo peso al nacer en el área salud Camilo Cienfuegos de Chambas, 2007-2008 / Factors influencing low birth weight in the health area Camilo Cienfuegos Chambas, 2007-2008

Se realizó un estudio observacional analítico retrospectivo de casos y controles para conocer los principales factores de riesgo que influyen en el bajo peso al nacer en el área de salud Camilo Cienfuegos del municipio Chambas en el periodo comprendido entre los años 2007 y 2008. La edad materna, el nivel de escolaridad, los hábitos tóxicos como el fumar y el consumo de alcohol, la hipertensión arterial, la sepsis vaginal y las condiciones económicas no favorables resultaron tener una asociación significativa con este fenómeno. Predominaron los partos pretérmino, también en relación con el nacimiento de un niño de bajo peso

A retrospective observational and analytical case-control study was conducted to ascertain the main risk factors that influence low birth weight in the health area Camilo Cienfuegos from Chambas municipality in the period between 2007 and 2008. Maternal age, educational level, toxic habits such as smoking and alcohol consumption, hypertension, vaginal sepsis, and unfavorable economic conditions were having a significant association with this phenomenon. The preterm deliveries were predominant, also in connection with low weight babies birth

Balance del contenido vaginal en el diagnóstico diferencial de vaginosis-vaginitis: Reacción inflamatoria vaginal en embarazadas sintomáticas / Balance of vaginal content in vaginosis-vaginitis differential diagnosis: Vaginal inflammatory reaction in symptomatic pregnant women

El objetivo del trabajo fue validar el alto valor predictivo de BACOVA (Balance del contenido vaginal, disponible en www.fba.org.ar/proeco) en el diagnóstico microscópico diferencial de vaginosis bacteriana (VB) y vaginitis microbiana inespecífica (VMI). Fueron estudiadas 299 embarazadas sintomáticas. Se determinó por microscopía el Valor Numérico (Nugent) (VN), células guía (CG), morfotipos extraños (Mex), leucocitos por campo (Lpc), tricomonas (TV) y levaduras (LE) con lectura a 400X. Los resultados globales fueron: VN de 7 a 10, 16,4% del total de casos. BACOVA permitió diferenciar 11,7% de los casos con VN de 7 a 10, con reacción inflamatoria vaginal (RIV) menor de 10 Lpc, como casos típicos de BV. Con igual VN se detectó 4,7% de casos con RIV con más de 10 Lpc, compatibles con VMI. En sólo 7,3% de los casos de LE detectadas por microscopía (20,4% en total), se confirmó una RIV significativa. Hubo 2,7% del total de casos con RIV significativa, pH<4,5 y resultado negativo para el resto de los criterios estudiados. La determinación de la RIV, fue imprescindible, junto al VN, en el diagnóstico diferencial de VB y VMI. La RIV también es necesaria para establecer la significación clínica de la presencia de levaduras. BACOVA detecta casos con RIV significativa (2,7%), como único marcador, con pH inferior a 4,5, compatibles con infección del tracto genital superior.

This study was undertaken to demonstrate the high diagnostic predictive value of BACOVA (Balance of Vaginal Content, www.fba.org.ar/proeco) for bacterial vaginosis and microbial non specific vaginitis, in pregnant women primary health care. BACOVA including Nugent score (Gram 1000X) and leucocyte count (Wet mount and Giemsa, using 400X) was evaluated in 299 symptomatic pregnant women. Nugent score 7 to 10 was detected in 16.4%. Crossing Nugent value 7 to 10 with leucocytes counts shows that only 11.7% were below 10 leucocytes per field and 4.7% had a significant vaginal inflammatory response. Yeasts were detected in 20.4% but only in 7.2% of cases they show a significant association with vaginal inflammatory response. In 2.7% of the cases there was a significant vaginal inflammatory response, with pH below 4.5, VN from 0 to 3 and negative for TV, fishy odor, and exogenous microbial morphotypes. Simultaneous study of vaginal inflammatory response and Nugent score is mandatory in order to detect true cases of bacterial vaginosis (11.7%) from those of potential microbial non specific vaginitis (4.7%) (Donders' "aerobic vaginitis") Besides, vaginal inflammatory response became a strong criterion to define yeast vulvovaginitis (7.2%). Cases (2.7%) with score 0 to 3, negative for other criteria, with a high vaginal inflammatory response, are predictors of upper genital infections.

A Gartner duct cyst of the vagina causing dysuria and dyschezia in a Yorkshire Terrier

A 5 year-old, intact female Yorkshire terrier was referred for dysuria and dyschezia. The radiographic and ultrasound examination showed a round shaped mass caudal to the urinary bladder that contained anechoic fluid within the thin walls. During surgery, the cyst was noted to be attached to the outer wall of the vagina, not connected to the vaginal lumen. Cystic fluid was removed and the cystic wall was resected. Then the remaining cystic wall was omentalized to prevent a recurrence. Histological examination confirmed that the cyst was of Wolffian duct origin. In this case, a large Gartner duct cyst causing urological problems was diagnosed and removed by surgical resection.

Vaginal bleeding in young children.

To evaluate prospectively vaginal bleeding in young children with emphasis on the cause, management and outcome, we analyzed the data of all children aged under 10 years old who presented with vaginal bleeding at the King Chulalongkorn Memorial Hospital between 1981 and 2000. There were 55 girls presenting with vaginal bleeding with variable degrees of severity. In 41 of the 55 girls (74.5%), the bleeding resulted from a local lesion of the genital tract. Genital tumors were seen in four girls, ie hemangioma of the vulva, sarcoma botryoides of the vagina, functional ovarian cyst and granulosa cell tumor of the ovary. In the remaining 14 girls (25.5%), the bleeding originated from systemic hormonal etiology. In one girl with precocious puberty, it was associated with hypothyroidism, whereas in the other six girls it was due to constitutional causes. In addition, the cause of bleeding in 10 girls was the vaginal manifestation of leeches, which is a unique problem for Thailand. Although vaginal bleeding in young children is rare, it can be an alarming clinical presentation, and serious underlying causes should be excluded. Prompt and correct diagnosis will lead to successful management.

Endometriosis en la cicatriz de episiotomía y en vagina. Informe de un caso y revisión de la literatura / Endometriosis in the episiotomy scar and vagina. Report of a case an review of the literature

A case report of external endometriosis (quite rare), pelvi-genital (vagina) and extrapelvic (on episiotomy scar) presentation. The profile of the patient was: 44 years old with residual right ovary after surgical procedure. The first symptoms were 18 years later of the last delivery. Literature review was done.

Infección cervicovaginal como factor de riesgo para parto pretérmino / Cervicovaginal infection as a risk factor for premature labor

OBJECTIVE: To identify the possible association between cervicovaginal infections (CVI) and preterm delivery. DESIGN: Cohorts. REFERENCE FRAME: Instituto Nacional de PerinatologÝa, Hospital Central Militar and Hospital General Regional No. 1, IMSS, Culiacßn, Sinaloa, MÚxico. PATIENTS: Four hundred and sixty eight patients attending prenatal control and delivery care. INTERVENTIONS: Fresh smears, Gram stain, and cervicovaginal sample culture from samples obtained during the following gestational stages: First sample at 16-24 weeks, second sample at 25-32 weeks, and third sample at 33-42 weeks. The following microorganisms were studied: Candida albicans, Gardnerella vaginalis, Ureaplasma urealyticum, Streptococcus agalactiae, Mycoplasma hominis, Neisseria gonorrhoeae, Listeria monocytogenes, and Chlamydia trachomatis. In case of a positive culture, the specific treatment was indicated. MEASUREMENTS: Positive or negative culture for each of the studied pathogens, and the presence or absence of a preterm delivery for each of the patients included in the study. RESULTS: Three hundred and ninety eight were still present at the end of the study, of which 156 had a CVI and 242 had no CVI. No differences between both groups were observed concerning preterm delivery. Significant relative risks were: In the first stage, Ureaplasma urealyticum and Mycoplasma hominis with RR = 9.0 (6.81, 11.8); in the second stage, Ureaplasma urealyticum with RR = 6.2 (3.30, 11.7) and Escherichia coli with RR = 3.4 (1.33, 8.6); in the third stage, Ureaplasma urealyticum with RR = 9.19 (6.93, 12.1). The logistic regression analysis identified Ureaplasma urealyticum during the second stage with OR = 16.6 (2.9, 93.7), statistically significant with p = 0.001. The survival analysis showed differences between the two groups concerning pregnancy duration (p < 0.001). CONCLUSIONS: There is a difference in the duration in pregnancy in patients with CVI and without CVI. Ureaplasma urealyticum is consistently associated with preterm delivery.

Manifestações pleuropulmonares das doenças ginecológicas / Pleuropulmonary manifestations of gynecological diseases

Os autores apresentam revisäo da literatura acerca das principais doenças ginecológicas inter-relacionadas com alterações pleuropulmonares. Devido à diversidade das doenças primárias que podem determinar tais manifestações a distância e ao fato de este assunto näo ser usualmente abordado em livros-textos, consideram importante esta revisäo, com o objetivo de auxiliar a prática clínica

Bacterial vaginosis: diagnosis and associations in vaginal discharge

Bacterial vaginosis [BV], the commonest cause of vaginal discharge, is thought to be polymicrobial in origin. The objective of this study was to evaluate the prervalence of BV in obstetrics and gynecological clinics, its rapid diagnosis regimen and its possible associations. One thousand and eighty patients, 16-55 years old, attending the outpatient clinics were included. Patients, all complaining of vaginal discharge, were clinically examined and subjected to approved rapid diagnostic techniques, isolation and identification of Gardnerella vaginalis [G. vaginalis] and anaerobes and the detection of urological mycoplasmas. The overall prevalence of BV was relatively low, accounting for 17.1%. G. vaginalis was identified in 95% of those with BV i.e 170/1080 [15.7 of all cases] whereas no anaerobes could be identified. Mycoplasma hominis [M. hominis] and Ureaplasma urealyticum [U. urealyticum] were detected and identified in 29/460 cases, 9 of which were in Gardnerella negative cases adding a 1.4% to the overall prevalence. G. vaginalis was identified in 29% of intrauterine contraceptive device [IUCD] users, 57% of patients with pelvic inflammatory disease [PID], 33% of patients with infertility and 24% of patients presenting with preterm labour. On the other hand, no association could be found between g. vaginalis and other forms of vaginitis, namely trichomonas vaginitis and vaginal candidiasis. Rapid diagnosis using a vaginal discharge pH of > 5 and Gram stained smear was extremely easy and reliable showing acceptable degrees of specificity and sensitivity. In fact these hand tools might give clues to early diagnosis and better management before the results of any cumbersome sophisticated investigations

Utero didelfo, imperfuracao vaginal unilateral e agenesia renal ipsilateral: descricao de um caso / Uterus didelphys, unilateral imperfurated vagina and ipsilateral renal agenesis: a case report

A combinacao do utero didelfo com imperfuracao vaginal unilateral e agenesia renal ipsilateral e rara e, em geral, e encontrada em mulheres com ciclos menstruais normais. Nestes casos, devido ao acumulo de sangue menstrual na hemivagina obstruida, as pacientes podem apresentar massa pelvica e dismenorreia severa. Neste artigo e descrito um caso de uma paciente de 14 anos, a qual apresentava dor pelvica ha 6 meses. Os autores revisam tambem a embriologia, diagnostico e manejo desta rara associacao